Struggling With Erectile Dysfunction? Try Physical Therapy

Despite benefits of pelvic exercises on erectile dysfunction, they mostly remained confined to women.

It is not just women, but also men who struggle with body image issues. Due to societal pressures, expectations and inflexible gender performance standards, erectile dysfunction (ED) can be a intimidating prospect for men.

Erectile dysfunction is defined as the inability to achieve or maintain an erection. There can be many causes of ED ranging from the emotional and psychological to the physical or neurological.

You might think the problem is squarely about something intrinsically wrong with your penis, but according to Chandigarh-based sexual health practitioner, Dr Deepak Arora, “an underdeveloped set of pelvic floor muscles could also be the source of your problems.”

So yes, there is a thing called working out to strengthen those muscles - pretty much the same way as women strengthen Kegel's muscles in their nether zones.

Physical Therapy Not Just For ED

Physical therapy (PT) for erectile dysfunction (ED) is definitely a thing, and a targeted workout may help you with lifting more than just your spirits.

For most men, the pelvic floor muscles aren’t exactly their priority when hitting the gym for a full body workout — but they should be. These muscles are critical for many essential daily functions, both in the bathroom and in the bedroom. Unfortunately, it's not common for men to seek help to strengthen their pelvic muscles.

“When men hurt themselves playing sports or otherwise, they’re not likely to get embarrassed to seek out an orthopaedist or physical therapist for help — but when it comes to an injury or problem with their muscles in the pelvic or penile region, men tend to be a little more private,” notes renowned sexologist Dr Prakash Kothari.

Despite common belief and focus on keeping up macho appearances, pelvic floor (PF) dysfunction isn’t just a woman-problem. Leakage with squats, pain during or after sex, and bowel or bladder incontinence are all signs of PF muscle dysfunction. Let it be known that penises have muscles too. And sometimes, like any other muscle in your body, they can be dysfunctional — so, you should see a physical therapist about those muscles too.

Pelvic floor physical therapy can address the muscular and nerve function required to achieve and maintain an erection.

Dr Prakash Kothari

Specifically, targeted PT can help a man strengthen and engage his ischiocavernosus muscle, which is responsible for building and keeping penile rigidity. That engagement can be honed through exercises like Kegels which have grown to become more common in women, but are woefully underperformed by men.

“Just like any other muscle, the pelvic floor muscles can be addressed with rehabilitation. A proper strengthening routine can target weakness, specifically, trigger points can be released where there is increased tension, restoring the correct length-tension relationship and creating more complete and stronger muscle contractions,” according to Dr Vinay Khanna, Chandigarh-based sports physiotherapist, who specialises in treating male and female pelvic health.

But before you start getting too creative with a DIY strengthening and massage routine, you must get a qualified specialist to assess and identify the source of the problem before determining the most appropriate treatment plan because it is a complicated set of muscles down there.

What Sort of Exercises?

Know this: A pelvic floor exam by a physical therapist may involve both external and internal soft tissue, neurological, strength and range of motion assessments.

By internal, this usually means very gentle assessment of the pelvic floor muscles via the rectum — so yes, you will need to be ready for the rubber gloves to go on. PF PTs know this may be uncharted territory for many men, so you should also know that internal exams usually don’t happen on the initial visit. Such procedures are always discussed prior to the exam and are only performed when a medical history and complete examination indicate that it is appropriate.

“PF PT is much more than range of motion exercises, soft tissue mobilisation and home-based exercises,” says Dr Khanna, who also stresses on patient education and lifestyle adjustments.

In particular, Dr Khanna underlines the importance of breathing and relaxation techniques. “Your diaphragm and your pelvic floor muscles are connected, therefore proper breathing is paramount. I often integrate pelvic floor physical therapy with Yoga asanas.”

Additionally, stress can exacerbate pelvic pain. Dr Kothari says many people "hold stress in their pelvis, just like others do in their neck and shoulders." Perhaps this is why Dr Arora also focuses on educating his patients to "avoid straining when going to the bathroom, not clenching muscles throughout the day, and global relaxation strategies such as meditation."

Not Just a "Woman Thing"

Despite a lot of men suffering from not just erectile dysfunction, but even other issues of the pelvic floor (infections, enlarged prostate, sport-related inflammations), not many seek physical therapy for their ED. Dr Kothari agrees and says:

Men aren’t the only ones lacking knowledge about the muscle group. Women are just starting to talk (whisper) about their pelvic floors, but only because they go through childbirth.

Dr Vinay Khanna believes the main reason men don’t seek pelvic floor physical therapy is because they don’t know it exists.

While there are a handful of excellent urologists, gastroenterologists, orthopedists and pelvic pain specialists who refer patients to PF physical therapy, unfortunately not all doctors are aware of this specialisation especially when it comes to men.

Dr Vinay Khanna

Dr Arora believes part of the issue has to do with common misconceptions. He notes that "men are often told ED is related to anxiety. When all the diagnostic testing and urine cultures are negative, they are treated with anti-anxiety medication before their pelvic floor muscles are thoroughly assessed. This can be particularly frustrating for men who begin to think 'it’s all in their head', when there is definitely a muscular component to their pain or discomfort."

The stigma of pelvic floor PT being just a “woman thing” will change as men learn more about the prevalence of male pelvic floor dysfunction, and also how it can be helped.

(Aarti K Singh is an independent writer with close to two decades' experience in various media. Having worked in radio, TV and print media, she is now indulging in her passion to rediscover the world, besides juggling a PhD and raising her son.)